Annual Meeting Proceedings Part 1 - American Society of Clinical ...

1588 General Poster Session (Board #7F), Sat, 1:15 PM-5:15 PM
Second primary gynecologic neoplasms among breast cancer survivors.
Presenting Author: Maria Pilar Barretina Ginesta, Institut Catala d’Oncologia
Hospital Universitari Josep Trueta, Girona, Spain
Background: Excess of risk of several second primary malignancies after
treatment for breast cancer (BC) has been reported. This risk can be related
with shared risk factors, cancer susceptibility genes or prior treatments
received. Hormonal factors and hormone therapy are known to be risk
factors for both BC and some gynecological malignancies. The aim of this
study was to asses gynecological cancer risk as a second neoplasm among
BC patients in our population. Methods: Patients diagnosed with invasive
BC (CIE10: C50.0-C50.9) and registered in the Girona Cancer Registry
from 1980 to 2006 were included in our study. We analyzed their
incidence of second gynaecological malignancies except for contralateral
BC. Standardized Incidence Ratios (SIR) and absolute excess of risk (AER)
of these patients compared to general population were calculated. Results:
6.209 patients were diagnosed of invasive BC in this period, with median
age at diagnosis 62 years, median follow-up 4 years. 84 of them developed
a second malignancy of gynaecological origin (SIR 1,98 CI 95% 1,59-
2,44; AER 104,01/100.000 person-year). We observed 4 uterine cervix
(SIR 0.64 IC95% 0,20-1,54), 3 vulvar-vaginal (SIR 0,96 IC95% 0,24-
2,60), 13 ovarian (SIR 1,13 IC95% 0,63-1,89) and 63 uterine corpus
neoplasms (UC), as well as 1 genital female tract neoplasm unspecified.
High and statistically significant SIR was observed for gynecological
malignancies in general and specifically for UC(SIR 3.14 IC 95% 2,44-
4,00). With this finding, histology of UC cases was reviewed. 12 out of 63
were malignant histologies, not otherwise specified. Among the remaining
51, there were 8 type II (1 clear cell and 7 serous adenocarcinoma,
15.7%), 34 type I (endometrioid adenocarcinoma, 66.7%) and 6 carcinosarcomas
(11.8%). There were also 2 adenosarcomas (3.9%) and 1
mucinous adenocarcinoma (1.9%). Conclusions: Women with previous BC
have an elevated risk of developing a second primary gynecological
malignancy compared with general population, particularly for UC. These
patients should be followed up for its early detection. We detected a slight
increase in unfavourable uterine carcinoma histologies respect to the
general population. Further investigation of this finding is warranted.
1590 General Poster Session (Board #7H), Sat, 1:15 PM-5:15 PM
Renal impairment after chemotherapy in lung (LC), colorectal (CRC), and
breast cancer (BC) patients (pts) from the Henry Ford Health System
(HFHS) tumor registry. Presenting Author: Laura Chu, Genentech, South
San Francisco, CA
Background: Renal impairment is a common comorbidity in cancer pts. It
can delay excretion and alter metabolism of anticancer drugs leading to
further renal toxicity. The objective of this study was to determine the
proportion of pts with renal impairment, defined as the presence of
proteinuria (PR), acute kidney injury (AKI), or chronic kidney disease
(CKD), after chemotherapy (chemo) initiation. Methods: LC, CRC, and BC
pts newly diagnosed between 2000 and 2007 (regardless of prior renal
status) were identified using the HFHS tumor registry, with follow-up
through Mar 2009. AKI was defined based on RIFLE (severity categories
only) using lab data within 1 to 7 days after chemo initiation. CKD was
defined based on NKF-KDOQI criteria and lab data up to 1 year after chemo
initiation. Proteinuria was defined as protein/creatinine �30 mg/g within 3
months after chemo initiation. Descriptive statistics include proportions
stratified by renal impairment status (yes, no) at cancer diagnosis. Results:
We identified 1,896 LC, 1,088 CRC, 1,611 BC chemo treated pts. Median
age for all pts was 66 years. For LC and CRC, 56% and 51% were men,
respectively. The proportion of pts with renal impairment after chemo by
tumor type was the following: LC (AKI�23.4%; CKD�48.2%; PR�0.4%);
CRC (AKI�20.3%; CKD�55.7%; PR�0.1%); BC (AKI�7.8%;
CKD�63.9%; PR�0.6%). Pts with pre-existing renal impairment at
cancer diagnosis were more likely to have impairment after chemo (Table).
Conclusions: In LC, CRC, and BC pts, the proportion of pts with renal
impairment after chemo initiation was high. Extent of renal impairment,
especially AKI, appears to be associated with tumor type. Older age, as in
this HFHS cohort, is associated with higher prevalence of CKD. Renal
function should be closely monitored, particularly among pts with preexisting
renal impairment, and preventive measures implemented to
minimize further toxicity after treatment.
Cancer Prevention/Epidemiology
107s
1589 General Poster Session (Board #7G), Sat, 1:15 PM-5:15 PM
The influence of prognostic factors on metastatic breast cancer survival
over time. Presenting Author: Margaret Quinn Rosenzweig, University
of Pittsburgh School of Nursing, Pittsburgh, PA
Background: Recent evidence suggests that survival in metastatic breast
cancer is slowly improving associated with the use of better adjuvant and
metastatic chemotherapeutic and targeted agents. Patient and clinical
factors such as age, estrogen status, non-white race, Her 2 status, disease
free interval and sites of metastatic breast cancer involvement indicate
worse clinical outcome after recurrence. This analysis focused on the
influence of these factors on metastatic breast cancer survival over time.
Methods: Subjects were women with metastatic breast cancer from one
large urban practice, of the University of Pittsburgh Cancer Institute Breast
Cancer Program followed from 1999 through December, 2008. Patients
were dichotomized into two time categories: A) 1999 through 2004 and B)
2005 through 2008. Outliers of long term survivors (n �72) with survival
extending beyond 6 years were excluded. Log rank tests were conducted for
assessing the relationship between prognostic factors and survival. Results:
Cohorts included patients diagnosed with metastatic breast cancer in 1999
through 2004, (n�284) and 2005 through 2008, (n�332). They were
followed up to December, 2011. Median survival improved over time
(p�0.053). Estrogen negativity remained significant for worse survival
across both time periods (p�0.0001). Age, presence of brain metastasis
and Her 2 status were not significant for influence on survival at either time
interval. Shorter disease free interval (p� 0.02), higher number of
metastatic sites (p�.001) and presence of visceral metastasis at diagnosis
(p�0.003) became significant for worse survival in the 2005-2008
intervals but had not been in the earlier time period. African American race
was highly significant (�0.001) for worse survival in 1999-2004 but lost
significance in 2005 through 2008 with dramatic survival increase
(median survival - 12.5 months to 35 months). Conclusions: It is important
for clinicians to clarify the prognostic features associated with worse
outcomes in metastatic breast cancer. With newly emergent therapies and
sensitivity toward specific patient factors these features evolve over time.
1591 General Poster Session (Board #8A), Sat, 1:15 PM-5:15 PM
Treatment patterns and comorbidities in a population-based cohort of
glioblastoma patients diagnosed 1997-2008. Presenting Author: Susan A.
Oliveria, EpiSource, Newton, MA
Background: Glioblastoma multiforme (GBM) is one of the most common,
most malignant and rapidly progressive forms of brain cancer. Published
reports of GBM in non-trial populations are limited. The purpose of this
study was to assemble a population-based cohort of GBM patients with
comprehensive clinical and demographic information and to define treatment
patterns and outcomes in this population. Methods: GBM patients
served by Henry Ford Health System (HFHS), a major GBM referral center,
were identified using ICD-O and histology codes from the HFHS tumor
registry. Eligible patients were newly diagnosed with GBM between 1997
and 2008. Comprehensive, population-based data were compiled using
tumor registry data (including histology and mortality) with linkages to
pharmacy data (including infusion), outpatient and inpatient encounter
data, and laboratory results. Results: Overall, 812 GBM patients were
identified; mean age was 54 years (standard deviation 15.8). The cohort
was 63% male and 84% white. Among the most common post-diagnosis
comorbidities/complications, 14% of patients had venous thromboembolism
(95% confidence interval [CI] 12-17), 16% had seizures (95% CI
14-19), and 6% had central nervous system hemorrhage (95% CI 4-7).
Arterial thromboembolism occurred in 3% of patients (95% CI 2-4), while
7% experienced infections such as candidiasis, herpes simplex, and
pneumocystis pneumonia (95% CI 5-9) and 2% experienced wound
dehiscence (95% CI 1-3). 94% (95% CI 93-96) of the cohort received
some form of treatment with 81% undergoing surgery (95% CI 78-84),
75% receiving radiation therapy (95% CI 72-78), and 67% receiving
chemotherapy (95% CI 64-70). Median overall survival after diagnosis was
1.4 years (95% CI 1.3-1.5) among all patients, and 1.6 years (95% CI
1.4-2.0) among those diagnosed 2005-2008. Conclusions: This study
presents a well-characterized population-based cohort of GBM patients.
Understanding treatment patterns and comorbidities outside the clinical
trial setting is important in informing and evaluating real-world treatment
decisions. Additional results exploring time trends in systemic cancer
therapy and Kaplan-Meier survival curves will be presented.
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